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The health effects of being out of work

At a glance:
People who are out of work are at greater risk of:

Poor physical health and wellbeing
Poor mental health
mental health
Emotional wellbeing. Ability to cope with difficulty and enjoy life. THe absence of a mental health problem.
 and wellbeing
Mental health problems
Suicide and suicide attempts
Social isolation and loss of self confidence
Work provides income, but it is also important to a person's mental wellbeing and self-belief. The roles people play in their family and in society are partly shaped by their work.

The longer someone stays off work, the less likely they are to return. Even after a few weeks their chances of returning are reduced. Many people who have been off work for a few years acknowledge that if they had known the path ahead they would have been much more proactive about their situation.

Being off work with an injury is difficult for most people. Aside from worries about health and problems coping with pain, there are the official or bureaucratic processes that need to be worked through and understood.

Work is an important goal in itself. It is an essential part of your recovery process. Try to get the support you need with the return to work process.
Work is important for people's health and well-being. A return to work is most likely to be successful when the employee is engaged, and feels like a productive member of the team.

Re-engaging people improves their well-being, and benefits the company.
This substantial review of a large body of literature provides solid evidence that work is generally good for people's health and well-being. Remaining off work is a hazard for medium to long-term health. It carries an increased risk of health problems and increased risk of death from a variety of conditions. A few weeks of sick leave may not seem a major problem, but we know that the longer someone stays off work the less likely they are to successfully return.

This review provides good evidence that treating practitioners
treating practitioner
A health professional that treats patients. In return to work this may include doctors, physiotherapists, chiropractors, osteopaths, psychologists, masseurs, etc.
 should give clear advice to patients. Many patients do not see the path ahead, and the authors of this paper call on treating practitioners to focus on the return to work as an important outcome
Mental health problems, depression,
A symptom of mood disorder characterized by intense feelings of loss, sadness, hopelessness, failure, and rejection. Major depression is likely to interfere significantly with everyday activity, with symptoms including insomnia, irritability, weight loss, and a lack of interest in outside events. The disorder may last several months or longer and may recur, but it is generally reversible in the short run.
 suicide and attempted suicide, heart disease, cancers, and overall rates of illness and death increase when people remain out of work.

Return to work is most successful when all parties work together towards a common goal. Clear communication and support for people with an injury is an important aspect of helping them back to work.
Original Article, Authors & Publication Details:
G. Waddell1, K. Burton2 and M. Aylward3 (2007).

Work and Common Health Problems. Journal of Insurance Medicine; 39(2):109-120.

1Waddell –Unumprovident Centre for Psychosocial
Refers to psychological and social factors. Examples of psychosocial factors that affect return to work area include: a person's beliefs about how they will cope with their condition, the attitude of the inured worker's family to their condition and return to work, the employer's return to work policy and the influence of the WorkCover system on a person.
 and Disability Research, Cardiff University, UK.
2Burton – Centre for Health and Social Care Research, University of Huddersfield, UK
3Aylward – Unumprovident Centre for Psychosocial and Disability Research, Cardiff University, UK
Background, Study Objectives, How It Was Done:
Over the last 25 years work has become safer, but sickness absence has increased. This paper was a review of a broad range of studies exploring the impact of work on health. Only the first part of this paper has been summarised here. Summaries of other parts of the paper can be found elsewhere on this site.
Study Findings:
The reviewers divided the analysis into the sections below.

1. Health effects of being out of work

There was strong evidence that being out of work has the following consequences:

Increased risk of dying
Increased risk of dying from heart disease, lung cancer, and suicide
Poorer physical health, including heart disease, high blood pressure and chest infections
Poorer general health and poorer self reports of health and well-being
Increased long-term illness
Poorer mental health and well-being.
Increased likelihood of suicide attempts
Higher rates of medical attendance and hospital admission

2. Health effects of being long-term out of work

The authors advised long-term worklessness is one of the greatest risks to health, with:

2-3 times the risk of poor health
2-3 times the risk mental illness
Significantly increased risk of depression
20% excess deaths

Long-term worklessness carries more risk to health than many “killer diseases," and more risk than most dangerous jobs (e.g. construction, working on an oil rig)

3. How being out of work affects health

The researchers examined the evidence, and evaluated the quality of each study to ensure that their conclusions were not inaccurate. They were clear that being out of work was actually causing or contributing significantly to poorer health.

4. Being out of work might affect health in the following ways:

Being out of work results in reduced income for most people. Reduced income has a negative effect on health, and also causes anxiety
Being out of work effects mood, which can have a negative effect on mental health
Some studies suggest that being out of work increases risky behaviours, such as increased smoking and decreased exercise. Not all of the evidence supports this view, however.
Being out of work for one period may increase the likelihood of being out of work again later on.

The authors note that although being out of work generally had negative effects on health, it can lead to improved health and well-being for a minority of people (about 5-10%). This seems to be the case when people are financially secure, and have made a positive decision to remain out of the workforce.

Health effects of re-employment:

When an individual returns to employment, signs of general health and well being improve. (E.g. self-esteem, self-reported health, physical health, and self-satisfaction.)
Returning to the workforce improves minor psychiatric health problems and psychiatric distress
The security of the new job, as well as the person's motivation and job satisfaction are important factors in improvement after returning to work

People who have returned to work are healthier than those who have not. One might assume that people with better health in the first place are simply more likely to return to work. However the researchers took this possibility into account, and concluded that most of the improvement was directly caused by re-employment.
The authors of this paper emphasized the importance of rehabilitation
The process of helping a person back to their former abilities and quality of life (or as close as possible) after injury or a medical condition.
 and supporting employees' return to work. They indicate that work is an important goal in itself, and an essential part of any recovery process.

Rehabilitation is not just a matter for doctors, but should be a focus of all parties in the work disability
A condition or function that leaves a person unable to do tasks that most other people can do.
 system. The authors comment that all players must work together to achieve common goals to care for individual patients and improve public health.
PubMed Abstract
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